Abstract:

We examined the frequency and clinical relevance of intracranial artery stenoses in patients with central nervous system (CNS) infections in whom the occurrence of stroke has angiographically been reported to be associated with stenoses or occlusions of the cerebral arteries. Thirty-eight patients with CNS infections underwent serial transcranial Doppler (TCD) ultrasound recording of mean blood velocity (MBV) and pulsatility index (PI) in the middle cerebral arteries (MCA), the anterior cerebral arteries (ACA), and the internal carotid arteries (ICA) on days 1,3,5,8,14, and 21 after admission. The results were correlated with the Glasgow Coma Scale (GCS) (days 1 to 14), and the Glasgow Outcome Scale (GOS) (day 21). AMCA stenosis was diagnosed by a MBV of 120 cm/s or more, or a MCA/lCA ratio of more than 3. An ACA stenosis was diagnosed by a MBV of 100 cm/s or more. In the 12 of 27 bacterial meningitis, a significant increase of MBV in the arteries was recorded, whereas in viral-induced and unclassified infections, no changes of flow velocity were seen. Transient stenoses occurred most frequently between days 3 and 8 and were detected. Patients with stenoses showed a significantly poorer mean GCS score on day 3 than patients without a stenosis. The mean GOS score was not significantly different between both groups. These results suggest that in the early phase, stenoses of the intracranial arteries occur frequently in bacterial meningitis, and are associated with a complicated course of the disease. Non-invasive monitoring by TCD ultrasound may be helpful for early detection of deterioration in cerebral hemodynamic trends.

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